Tag Archives: epidemiology

Animals and humans interact in many more ways than we think about in domestic suburbia. Sure, we know that animal farmers are constantly in contact with their produce, and we are happy to pet our domestic cats and dogs. Sure we recognize that some wild animals get rabies or, here in the desert of New Mexico, occasionally someone comes down with plague because of flea bites from infected indigenous rodents (our first case of this year was just last week). And we’ve all heard of bird flu.

Yet there are many more ways that animals and humans interact that can compromise the health of individuals or populations. In an excellent summary article, “Links among Human Health, Animal Health, and Ecosystem Health” Peter Rabinowitz and Lisa Conti from the Yale School of Medicine discuss how small-scale animal agriculture, human migration patterns and travel, animal worker practices, housing and land use development, changes in indigenous wildlife species, toxic hazards like the mercury poisoning in Minimata, Japan, and climate change impact animal and human health synergistically.

In 2007 the American College of Preventive Medicine (ACPM) Policy Committee, of which I was a member and former Chair, passed a resolution introduced by the late Ron Davis urging the American Medical Association to “support an initiative designed to promote collaboration between human and veterinary medicine…encourage joint efforts in clinical care through the assessment, treatment, and prevention of cross-species disease transmission…AMA support cross-species disease surveillance and control efforts in public health…support joint efforts in the development and evaluation of new diagnostic methods, medicines, and vaccines for the prevention and control of diseases across species…[and] engage in a dialogue with the American Veterinary Medical Association to discuss strategies for enhancing collaboration between the medical and veterinary medical professions in medical education, clinical care, public health, and biomedical research.”

The AMA passed this resolution and has been a leader in encouraging the consideration of these issues. The American College of Preventive Medicine has recently participated in a One Health capitol hill briefing and renewed its endorsement of the One Health initiative. However, the greatest push to understand and deal with animal-human medical interactions has come from the veterinary community. The medical community has been relatively quiescent on the issue unless an epidemic occurs. When one looks at the One Health Commission there are only two MD individual members of the Board of Directors, and only one MD on the Council of Advisers. (There are twelve on the honorary advisory board of the One Health Initiative.)

Who are the MD leaders concerned about this issue? Mostly they are epidemiologists, infectious disease specialists, or ag-related occupational medicine specialists. Two out of three of these specialists are under the medical specialty of preventive medicine. There aren’t very many of us trained in preventive medicine. The Institute of Medicine in 2007 estimated there are about 10,000 in the US and that we’d need another 10,000 over the next few years. To quote from a report from ACPM:

Between 1999 and 2006, the number of residents enrolled in preventive medicine training programs declined nearly 20%, and in 2007-08 less than half of the approved number of residency positions were filled.

The number of preventive medicine residency programs decreased from 90 in 1999 to 71 in 2008-2009.

These trends have not abated. The demand for such residencies has not decreased – it has always been high according to preventive medicine residency directors. The problem is funding – preventive medicine is the one specialty not consistently mostly supported by the federal government. Hence for those residency programs in existence, most can only find funding to fill half of their slots (and many approved residencies’ doors aren’t even open).

For human medicine to be fully engaged in the One Health initiative we need more human medicine physicians to be engaged in preventive medicine, which means more federal funding for residencies. But as with prevention in general, western society tends to provide less than what is needed in the balance with treatment.